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Tuesday, November 1, 2011

Biocultural Perspectives on Appalachian Anthropology

My road to scholarly work in Appalachia has been bumpy with many turns along the way.
In fact, if you had asked me two years ago if I thought I’d be working in the
region I would have said “no.” However, sometimes we are just as surprised as
our advisers, friends, and family members where our research takes us. This is
a personal account of my intellectual journey and how Appalachian Studies plays
an important role in my academic career.

Entering
the Field

As a new anthropology PhD student in 2010, I was offered a funded graduate research
assistant (RA) position in the department of behavioral sciences. A past
graduate of the anthropology program, friend, and co-author of mine had recommended
meeting with faculty outside the department when I visited the university
before I had received my acceptance letter to the program. I am very glad I did
meet with so many faculty that day, and that I apparently didn’t make a total
fool of myself, because that opportunity has led me on the path that I follow
today.

When I entered the program, my goal was to study malnutrition in Africa but my RA work
took me to the hills of Eastern Kentucky to work on community-based
participatory research (CBPR) health projects. What started as a very
successful faith-based cervical cancer screening project evolved into multiple
projects that now aim to increase cancer screening, fruit and vegetable intake,
and physical activity while reducing body mass index (where appropriate) by
reaching community members within their churches (Schoenberg et al. 2009). Community-based participatory work
often engages local communities with academics who strive for a partnership
approach to research that result in high participation and program success as
well as community capacity building (Israel et al. 2010). I had done CBPR work
for a few years before starting with these projects in Eastern Kentucky but the
work in Appalachia was somehow different, transformative. I became much more
interested in the structural barriers to healthy living that I was witnessing
in this remote, rural environment.

“They Made Themselves Fat”

Most public health work in the region (well in the nation, really) is frustratingly
focused on individual behaviors, in what anthropologists usually refer to as “blaming
the victim” (Moffat 2010) because individuals are blamed for making themselves
unhealthy. This is most evident in the recent obesity “epidemic” discourse
where lifestyle is a “choice” and unhealthy behaviors become conflated with
risk factors that do not account for structural barriers to healthy living.
Common misconceptions are that Appalachians do not know how to eat healthy, lay
around all day and collect welfare, and so maybe they deserve the
extraordinarily high rates of morbidity and mortality experienced in the
region. For example, in 2008, 70% of Kentucky’s adults were overweight or
obese, 30% of adults that had been screened had high blood pressure, 39% had
high cholesterol, and 10% had diabetes, with even higher percentages existing
in Eastern Kentucky counties (CDC 2008). But of course these percentages cannot
include many of the rural residents who have not been screened or surveyed and
these rates have been increasing in recent years.

Since individual food choices are often implicated in obesity and chronic disease
research, I became interested in the other factors that contribute to unhealthy
eating. For example, I am currently working on a project to measure the food
environment in several Eastern Kentucky counties. This form of “ground
truthing,” which involves visiting grocery and convenience stores to assess the
food options (Sharkey and Horel 2008), has not been attempted in Eastern
Kentucky and should allow us to evaluate access to grocery stores and the
quantity and quality of healthy foods available to rural residents (Glanz et
al. 2007). In this way, researchers can measure how far people must drive to
get to to a store (which is of course difficult to impossible without a car or
reliable public transportation), what kind of stores are within a reasonable
driving distance (convenience, grocery, or dollar stores), and the types of
foods that are available in these venues. Once this these barriers are measured
and published, it should become difficult to blame low-income rural residents
for eating poorly when the evidence indicates they must drive for 45 minutes to
get to a grocery store with any produce.

“This is the Price We Pay for Living in the Mountains”

As a biocultural anthropology student, I am very interested in the role the
environment plays in rural health. The environment limits access to healthy
food and opportunities for physical activity. However, the environment itself
can make people sick. This was especially salient for me working in Martin
County, KY during the summer of 2011. With a number of other social science
graduate students, I conducted survey research about the 2000 coal sludge spill
that leaked over 300 million gallons of coal waste into the Coldwater and Wolf
Creeks, which made it 30 times the magnitude of the Exxon Valdez spill (Scott
et al. 2005). Receiving little to no national recognition, this coal sludge
spill is implicated by community members in poor water quality, environmental
degradation, and high rates of cancer in the region (Scott et al., forthcoming;
B.M. Howell field notes).

What I found especially interesting about this follow-up research is that anger and
distrust toward the coal companies has waned significantly over the past 10
years since the spill. Some people believe that things are back to the way they
were before the spill, with a few commenting that things might even be better now
that large-scale clean-up efforts have improved the local environment. A number
of people were hostile to our research, stating that they were “friends of coal”
and they didn’t want to take our surveys. One individual even commented that
environmental disasters are the price they pay for their livelihoods in Martin
County. Of course, that is not to mention that this livelihood makes Martin
County one of the poorest counties in the state of Kentucky, Appalachia, and
even the nation. In fact, as of May 2011 Martin County is ranked at 39 among
the lowest income per capita counties in the entire nation. Only four of
Kentucky’s 120 counties are poorer than Martin County (U.S. Census Bureau
2010).

It’s All about Structural Inequalities

These two disparate Appalachian research projects coalesce around issues of
structural inequalities that lead to poor health. In Martin County, economic
dependence on the coal companies has resulted in acceptance, and even some
fatalistic attitudes, of environmental toxins. In southeastern Appalachian
Kentucky, many people have little access to high quality and varied fresh
produce and other healthy foods (this is probably true throughout Eastern
Kentucky, but I am only working in the southeast). By revealing the underlying
structures that create these inequities, many Appalachian researchers hope to
eliminate victim blaming, especially when Appalachians have come to blame
themselves for situations that they cannot fully control.

Both of these Appalachian projects utilize CBPR approaches to empower local communities
to take action regarding their health and the environment. Althought access to
healthy food and a toxin-free environment are basic human rights (United
Nations 1948), many Appalachian communities are not granted these conditions.
However, many Appalachian communities are willing and able to make changes that
they deem important. I argue that the best research approach to research in the
region is with CBPR which involves community members in all phases of the
process, from formulating questions to data analysis, interpretation, and
dissemination (Vaughn, Forbes, & Howell 2009).

Appalachia and Beyond

My work in Appalachian Kentucky has been integral for the development of my current
research interests and future PhD dissertation work. Although I will be
conducting dissertation research in Alaska, very similar issues of rural access
to food and complex dietary decision-making link the two regions. In Alaska,
these issues of food are complicated further by the harsh arctic environment
and discourses of race involving the rights of low-income indigenous residents
to continue obtaining traditional lifestyles and foods, such as seal and whale
(Loring & Gerlach 2009). But, it is my work in Appalachia that helps me
(begin to) grasp the structural inequalities in rural regions that I hope to
investigate throughout my career.

Additionally, my work in the region has helped me find my roots. Growing up in the Detroit
area, I was never really aware of my own heritage in the mountains. My father
made a few references to family members “down south,” but it meant little to me
because I had never met them. During my entire childhood I only visited
relatives in Pikeville, KY once and all I remember is my brother having a
pretty serious trampoline accident and my first encounter with wood ticks.
However, working in Eastern Kentucky has helped me form a deeper relationship
with my own father and to understand him and his family in a different way. In
fact, his family was part of one of the major waves of migrations out of the
mountains and into local industrial centers such as Cincinnati, OH and Detroit,
MI (Obermiller 2004). Because he was not born in the mountains, my father was
not aware of the term “Appalachian” and its current local meaning. We have had
many interesting and rich conversations in the past two years due to my work in
Eastern Kentucky. While it seems by accident that I ‘fell’ into Appalachian
studies, it is for these and many more reasons that I am not struggling to get
out of it.